Delayed Colonic Stricture and Obstruction after Blunt Abdominal Trauma: A Case Report and Review of the Literature Matthew Lublin, MD, Sara Chauvin, MD, Massoud Kashani, MD, Ibrahim Ibrahim, MD, and Mark Kahn, MD J Trauma. 2004;57:193–195. C olonic obstruction secondary to stricture is a rare but recognized complication after blunt abdominal trauma. We report a case of posttraumatic colonic obstruction and review the 15 other reported cases since the initial de- scription in 1952. 1–13 Presentation, diagnosis, and manage- ment are discussed. CASE REPORT The patient, a 28-year-old man, suffered blunt trauma from a motorcycle crash. A computed tomographic (CT) scan of the abdomen and pelvis at the time of trauma did not reveal internal injuries. He did sustain a left fibular fracture and a hairline pelvic fracture. For the first 3 months after the crash, the patient experienced crampy abdominal pain, with a change in bowel habits. After developing nausea and emesis, he presented to the emergency room. Physical examination revealed slight abdominal distension. His white blood cell count was within normal limits. An abdomen/pelvis CT scan revealed inflammation in the mid-descending colon, with a transition zone of dilated descending colon and decompressed sigmoid colon. Diverticulitis was suspected. Symptoms re- solved with intravenous hydration, antibiotics, and bowel rest. The patient did not return to scheduled follow-up visits. For the next 5 months, the patient continued to suffer from crampy abdominal pain. Approximately 8 months after the original trauma, he again presented to the emergency room with massive abdominal distention. A CT scan of the abdomen and pelvis revealed colonic distention, with a distal left colon transition zone, consistent with large bowel ob- struction. Because of the extreme distention, fear of perfora- tion, and unknown cause of the obstruction, a right transverse loop colostomy was performed for decompression. A post- surgical barium enema revealed a high-grade stricture involv- ing the mid-sigmoid colon (Fig. 1). Colonoscopy failed to visualize the lesion due to angulation of the sigmoid colon distal to the lesion. Three weeks after the colostomy, the patient underwent a laparoscopy-assisted sigmoid resection. Intraoperatively, the sig- moid was noted to be firmly adherent to the left lateral abdom- inal wall and surrounded by dense omental adhesions. Patho- logic examination of the resected specimen revealed a strictured area of the mid-sigmoid, which was 2 cm in length and 0.9 cm in diameter. The area of stricture was remarkable for serosal fibrous adhesions and a markedly increased bowel wall thick- ness. Histologic sections from the area of stricture exhibited fibrosis of the entire bowel wall, most prominent in the submu- cosa, and focal mucosal changes consistent with chronic isch- emia. The area of sigmoid distal to the stricture was histologi- cally unremarkable. Three weeks later, the transverse loop colostomy was closed without complication. Presently, 6 months after colostomy closure, the patient is well, without recurrent episodes of abdominal pain or distention. DISCUSSION Delayed colonic obstruction after blunt abdominal trauma is a rare but recognized complication. In 1952, Jones and Settle reported the first case of delayed colonic obstruc- tion caused by nonpenetrating colonic trauma. In this index case, a logger presented with severe abdominal pain 2 months after being struck in the abdomen by a boom log. 4 Other cases in the foreign literature, as summarized by Mays and Noer, have been reported. 11 Delayed obstruction of the small bowel has also been described after blunt trauma. 14,15 Since the initial description in 1952, 15 cases of colonic stricture after blunt abdominal trauma have been reported. 1–13 The clinical features, including our case report, are summa- rized in Table 1. Fourteen (88%) patients were male. The median age at time of presentation was 36 years (range, 24 –75 years). This differs significantly from the median age of patients presenting with large bowel obstruction secondary to carcinoma, who are usually much older. 16 The most com- mon mechanism of injury was motor vehicle crash, occurring in seven patients. In the United States, people under the age of 45 account for 62% of all hospitalizations and 80% of all emergency visits as a result of motor vehicle collisions. 17 Patients presented with obstructive symptoms a median of 20 weeks (range, 1–234 weeks) after initially suffering Submitted for publication June 14, 2002. Accepted for publication August 21, 2002. Copyright © 2004 by Lippincott Williams & Wilkins, Inc. From the Departments of Surgery (M.L.) and Pathology (S.C.), Mount Sinai Hospital, New York, New York, and Departments of Pathology (M.K.) and Surgery (I.I., M.K.), Englewood Hospital, Englewood, New Jersey. Address for reprints: Matthew Lublin, MD, 1249 Park Avenue, Suite 8A, New York, NY 10029; email: matthew_lublin@yahoo.com. DOI: 10.1097/01.TA.0000037287.09340.51 CASE REPORT The Journal of TRAUMA  Injury, Infection, and Critical Care Volume 57 • Number 1 193